Technical Considerations in Stoma Creation

Abstract

Creating an intestinal stoma is commonly the final aspect of an often emergent and complicated operation under difficult circumstances. While creation of a protruding, tension-free, and well-vascularized stoma is often straightforward, one must be prepared for challenging situations such as a thick abdominal wall and short, thickened mesentery. A successful stoma starts with attentive preoperative planning including site marking, thoughtful consideration of alternatives, and attention to technical detail. The tips provided in this article should facilitate the process of selecting the appropriate intestinal segment, identifying the correct stoma site, and creating a functional stoma even in the most challenging situations. Constructing a high-quality stoma will decrease complications and improve the patient's quality of life. Stoma creation is frequently the only component of an operation that the patient will have to live with for the remainder of his/her life.

Keywords

ileostomy - colostomy - surgery - stoma - surgical repair

• References

• 1 McLeod RS, Lavery IC, Leatherman JR. , et al. Factors affecting quality of life with a conventional ileostomy. World J Surg 1986; 10 (03) 474-480
• 2 Mengual-Ballester M, García-Marín JA, Pellicer-Franco E. , et al. Protective ileostomy: complications and mortality associated with its closure. Rev Esp Enferm Dig 2012; 104 (07) 350-354
• 3 Shiomi A, Ito M, Saito N. , et al. Diverting stoma in rectal cancer surgery. A retrospective study of 329 patients from Japanese cancer centers. Int J Colorectal Dis 2011; 26 (01) 79-87
• 4 Williams NS, Nasmyth DG, Jones D, Smith AH. De-functioning stomas: a prospective controlled trial comparing loop ileostomy with loop transverse colostomy. Br J Surg 1986; 73 (07) 566-570
• 5 Carne PWG, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg 2003; 90 (07) 784-793
• 6 Brandsma HT, Hansson BM, V-Haaren-de Haan H, Aufenacker TJ, Rosman C, Bleichrodt RP. PREVENTion of a parastomal hernia with a prosthetic mesh in patients undergoing permanent end-colostomy; the PREVENT-trial: study protocol for a multicenter randomized controlled trial. Trials 2012; 13: 226
• 7 Sohn YJ, Moon SM, Shin US, Jee SH. Incidence and risk factors of parastomal hernia. J Korean Soc Coloproctol 2012; 28 (05) 241-246
• 8 De Raet J, Delvaux G, Haentjens P, Van Nieuwenhove Y. Waist circumference is an independent risk factor for the development of parastomal hernia after permanent colostomy. Dis Colon Rectum 2008; 51 (12) 1806-1809
• 9 Hamada M, Ozaki K, Muraoka G, Kawakita N, Nishioka Y. Permanent end-sigmoid colostomy through the extraperitoneal route prevents parastomal hernia after laparoscopic abdominoperineal resection. Dis Colon Rectum 2012; 55 (09) 963-969
• 10 Lian L, Wu XR, He XS. , et al. Extraperitoneal vs. intraperitoneal route for permanent colostomy: a meta-analysis of 1,071 patients. Int J Colorectal Dis 2012; 27 (01) 59-64
• 11 Elliot-Smith A, Painter NS. Experiences with extraperitoneal colostomy and ileostomy. Gut 1961; 2: 360-362
• 12 Aquina CT, Iannuzzi JC, Probst CP. , et al. Parastomal hernia: a growing problem with new solutions. Dig Surg 2014; 31 (4-5): 366-376
• 13 Figel NA, Rostas JW, Ellis CN. Outcomes using a bioprosthetic mesh at the time of permanent stoma creation in preventing a parastomal hernia: a value analysis. Am J Surg 2012; 203 (03) 323-326 , discussion 326
• 14 Brandsma HT, Hansson BM, Aufenacker TJ. , et al. Prophylactic mesh placement to prevent parastomal hernia, early results of a prospective multicentre randomized trial. Hernia 2016; 20 (04) 535-541
• 15 Williams NS, Nair R, Bhan C. Stapled mesh stoma reinforcement technique (SMART)--a procedure to prevent parastomal herniation. Ann R Coll Surg Engl 2011; 93 (02) 169
• 16 Williams NS, Hotouras A, Bhan C, Murphy J, Chan CL. A case-controlled pilot study assessing the safety and efficacy of the Stapled Mesh stomA Reinforcement Technique (SMART) in reducing the incidence of parastomal herniation. Hernia 2015; 19 (06) 949-954
• 17 Correa Marinez A, Erestam S, Haglind E. , et al. Stoma-Const--the technical aspects of stoma construction: study protocol for a randomised controlled trial. Trials 2014; 15: 254
• 18 Meguid MM, McIvor A, Xenos L. Creation of a neoabdominal wall to facilitate emergency placement of a terminal ileostomy in a morbidly obese patient. Am J Surg 1997; 173 (04) 298-300
• 19 Horwood J, Hay D. The ‘glove cuff’ technique for difficult stomas. Ann R Coll Surg Engl 2009; 91 (05) 438
• 20 Meagher AP, Owen G, Gett R. Multimedia article. An improved technique for end stoma creation in obese patients. Dis Colon Rectum 2009; 52 (03) 531-533
• 21 Klein FA, Herr HW, Sogani PC, Whitmore Jr WF. Panniculectomy in conjunction with radical cystectomy in the obese patient. Surg Gynecol Obstet 1983; 156 (01) 31-33
• 22 Zolfaghari S, Gauthier JC, Jarmuske MB, Boushey RP. Panniculectomy: an alternative approach to the revision of a difficult stoma. Colorectal Dis 2011; 13 (07) e176-e177
• 23 Arai Y, Okubo K. Correction of dermal contour defect with collagen injection: a simple management technique for difficult stomal care. J Urol 1999; 161 (02) 601-602